BURNS AND SCALDS 187
due to the gravitation of blood to the dependent parts. There being no
destruction of the tissue, no scar results from, this kind of burn.
Second Degree. — This comprises acute inflammation and formation of
\iesiclesjproduced by the prolonged application of flame, liquids at a boiling
point or solids much above the boiling point of water. Vesicles can be
produced by the Application of strong irritants or vesicants, such as cantha-
rides. Vesicles may also be produced on the part of the body which is
allowed to soak in a decomposing fluid, such as urine or faeces, and subject
to warmth, especially in the case of a patient who is bed-ridden from some
nervous disease or old age, and is not properly nursed. If burns are caused
by flame or a heated solid substance, the skin is blackened, and the hair
singed at the seat of lesion, which assumes the character of the substance
used. No scar results as only the superficial layers of the epithelium are
destroyed. Some slight staining of the skin, however, may subsequently
remain.
Third Degree. — This refers to the destruction of ths cuticle and part of
the true skin, which appears horny and dart", owing io it having been
charred and shrivelled up. The nerve endings are exposed in this form of |
burn, and hence it is the most painful. This leaves a scar, but no contrac-
tion, as the scar, which forms after healing, contains all the elements of the
true skin, and consequently the integrity of the part is retained.
Fourth Degree. — This means the destruction qfj^e^whole skin. Hie
sloughs which form are yellowish-brown and parchment-like, and separate
out from the fourth to the sixth day, leaving an ulcerated surface, which
heals slowly forming a scar of dense fibrous tissue with consequent contrac-
tion and deformity of the affected parts. On account of the complete
destruction of the nerve endings this kind of burn is not very painful
Fifth Degree. — This includes the penetration of the <teep fascia and
implication of the muscles, and results in great scarring and deformity.
Sixth Degree. — This involves charring of the whole limb, and ends in
inflammation of the subjacent tissues and organs, if death is not the imme-
diate result.
Effects of Burns. — Burns and scalds vary in their effects according to
the following conditions: —
1. The degree of heat applied. 4. The site.
2. The duration of exposure. 5. The age of the patient
3. The extent of the surface. 6. The sex.
1. The Degree of Heat Applied*— Hie effects are much more severe if
the heat applied is very great.
2. The Duration of Exposure. — The symptoms are also more severe, if
the application of heat is continued for a long time.
3. The Extent of the Surface. — The involvement of one-third to one-
half of the superficial surface of the body is likely to end fatally.
4. The Site. — Extensive burns of the trunk, even though superficial, are
much more dangerous than those of the extremities. Burns of the genital
organs and the lower part of the abdomen are often fatal.
5. The Age of the Patient — Children are more susceptible to burns, bat
stand prolonged suppuration better than adults. Aged people bear bums
well. , h •
6. The Sex* — Sensitive and nervous women, are more
burns than strong women, and women generally do not bear burns so ,4m
as men*